General internists are expected to play a pivotal role in providing healthcare as the population ages, the burden of chronic disease grows, and healthcare reform tries to improve coverage for millions of currently uninsured patients. Studies suggest that only 20% to 25% of internal medicine (IM) residency grad­uates pursue general medical careers. Complicating the problem is that fewer medical students appear to be interested in general medicine and primary care. Career Plans Among Internal Medicine Residents It’s unclear to what degree primary care training program graduates favor general IM careers, and few studies have explored how career plans may differ across sociodemographic factors. In JAMA, Denise M. Dupras, MD, PhD, and I had a study published that looked at the career plans of IM residents by training program, sex, and medical school location. We also looked at how career plans evolved during training. According to our results, graduates of primary care IM training programs, women, and medical school graduates were more likely than their counterparts to report generalist career plans. These residents were also more likely to remain interested in generalist careers over the course of their training. However, general medicine career plans were less common than subspecialty career plans in each of these groups. The small number of IM residents reporting plans for generalist careers means that only a limited number of generalists can be expected to enter practice each year. Serious Implications on General Internal Medicine Overall, only one in five IM graduates planned a career in general internal medicine. Even in primary care IM residency programs that are dedicated to generalist and primary care training, most graduates still...

Previous research has indicated that many physicians throughout the United States experience professional burnout, a syndrome characterized by emotional exhaustion, depersonalization, and a low sense of personal accomplishment. Studies suggest that burnout can reduce quality of care and increase risks for medical errors, among other negative consequences. Furthermore, there are other adverse personal consequences for physicians that have been linked to burnout, including contributions to broken relationships, problematic alcohol use, and suicidal ideation (read guest blogger, Dr. Rob’s, Top 10 Burnout Triggers). “We have limited data characterizing physician burnout, but few studies have evaluated rates of burnout among U.S. physicians nationally,” says Colin P. West, MD, PhD. “Previous investigations have speculated on which medical or surgical specialty areas are at higher risk, but these analyses have not been definitive.” He adds that research is also lacking on how rates of burnout for physicians compare with rates for U.S. workers in other fields. Medical Specialty Matters in Burnout In the Archives of Internal Medicine, Dr. West and colleagues published a study on burnout involving a large sample of U.S. physicians from all specialty disciplines using the American Medical Association Physician Masterfile. Surveys were used to assess the prevalence of emotional exhaustion, enthusiasm dissipation, cynicism, depression, suicidal tendencies, negative views on work-life balance, and low professional esteem among physicians. After collecting responses from 7,288 physicians from various healthcare settings, 45.8% reported experiencing at least one symptom of professional burnout. “We observed substantial differences in burnout by specialty,” says Dr. West (Figure). The highest rates of burnout were seen in physicians at the front lines of care, most notably family doctors, general...